Cost-effectiveness of ensartinib, crizotinib, ceritinib, alectinib, brigatinib and lorlatinib in patients with anaplastic lymphoma kinase-positive non-small cell lung cancer in China

Abstract

ObjectiveSix anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs), including one domestic (ensartinib) and five imported ALK-TKIs (crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib), have been recommended as first-line treatments for advanced ALK-positive NSCLC in China. This study sought to examine the cost-effectiveness of these six novel therapies in Chinese patients.Material and methodsWe constructed a Markov model to compare the cost-effectiveness of the six ALK-TKIs as a first-line treatment for patients with advanced ALK-positive NSCLC from the perspective of the Chinese healthcare system. Transition probabilities were estimated by synthesizing data from the PROFILE 1,029 trial and a network meta-analysis. Health state utilities and costs were sourced from published literature, publicly available national databases, and local general hospitals. The robustness of model was assessed via deterministic sensitivity analyses and probabilistic sensitivity analyses.ResultsCompared with crizotinib, ensartinib achieved additional 0.12 quality-adjusted life-year (QALY) with marginal costs of $3,249, resulting in an incremental cost-effectiveness ratio (ICER) of $27,553/ QALY. When compared with ceritinib and brigatinib, ensartinib achieved additional 0.06 and 0.03 QALYs with substantially reduced costs. When compared with lorlatinib and alectinib, ensartinib was associated with a lower QALY and decreased total costs; the ICERs for lorlatinib and alectinib were $934,101/ QALY and $164,888/ QALY, respectively.ConclusionFor Chinese patients with advanced ALK-positive NSCLC, ensartinib was a cost-effective option compared with crizotinib, and was a dominant alternative to ceritinib and brigatinib. Although lorlatinib and alectinib were associated with prolonged survival compared with ensartinib, they were less cost-effective than ensartinib due to the overwhelming total costs.

Cost-effectiveness of first-line versus second-line use of brigatinib followed by lorlatinib in patients with ALK-positive non-small cell lung cancer

“…Our study in combination with previous researches on costeffectiveness of cancer treatment (31,59,60), emphasizes the urgency to explore alternative pricing strategies due to the high costs associated with cancer agents. Value-based pricing (61), indication-specific pricing (62), or a subscription model ( 63) could be potential options to explore.…”

“…Previous studies evaluated the economic value of regimen regarding brigatinib for individuals who have ALK-positive NSCLC (29)(30)(31). The incremental cost-effectiveness ratio for these studies varies, for example, Cranmer et al (29) both applied clinical data from the ALTA-1 L and ALEX trials to assess brigatinib from a United States perspective, which demonstrated that brigatinib provided better results than crizotinib, resulting in an increase of 0.97 quality-adjusted life-years (QALYs).…”

Cost-effectiveness analysis of axicabtagene ciloleucel as a second-line treatment for diffuse large B-cell lymphoma in China and the United States

“…19 China’s clinical testing and management costs referred to the research by Zhu et al . 20 The costs of AEs for CAR-T referred to the study by Luo et al 21 and were converted based on incidence. 7 Follow-up and physical examination data were collected after expert consultation.…”

“…18 The winning bid prices in each province in 2021 were queried on 'Yaozhi.com' to obtain the cost of the remaining pretreatment drugs. 19 China's clinical testing and management costs referred to the research by Zhu et al 20 The costs of AEs for CAR-T referred to the study by Luo et al 21 and were converted based on incidence. 7 Follow-up and physical examination data were collected after expert consultation.…”